Chem Path

Question 1

Drug causes of hyperkalaemia

Answer 1

potassium sparing diuretics, ACE inhibitors, angiotensin 2 receptor blockers, spironolactone, ciclosporin, heparin

Question 2

Cushing’s like symptoms with a normal dexamethasone suppression test

Answer 2

Chronic alcohol abuse

Question 3

Erratic blood glucose control, bloating and vomiting

Answer 3

Gastroparesis

Question 4

hypothyroidism + goitre + anti-TPO

Answer 4

Hashimoto’s thyroiditis

Question 5

Every person treated with insulin should have a … for emergencies

Answer 5

Glucagon kit

Question 6

Thyroid cancer, increased calcitonin

Answer 6

Medullary

Question 7

An elevated TSH with normal T4

Answer 7

Subclinical hypothyroid

Question 8

can cause fluid retention and is therefore contraindicated in patients with heart failure.

Answer 8

Pioglitazone

Question 9

Management for subclinical hyperthyroidism

Answer 9

Repeat TFTs in a few months

Question 10

First line management for painful diabetic neuropathy

Answer 10

amitriptyline, duloxetine, gabapentin or pregabalin

Amytryptiline contraindicated in BPH, may cause urinary retention

Question 11

Management for post menopausal women who has had a fracture

Answer 11

Risedronate and calcium supplements

Question 12

First line management of newly diagnosed T1DM

Answer 12

basal–bolus using twice‑daily insulin detemir

Question 13

best test to diagnose Addison’s disease

Answer 13

Short SynACTHen

Question 14

Test to confirm Phaeochromacytoma

Answer 14

24 hr urinary metanephrines, not catecholamines

Question 15

Bleeding gums: which vitamin deficiency

Answer 15

vitamin C

Question 16

Diarrhoea, confusion, eczematous skin. Which vitamin deficiency

Answer 16

Niacin

Question 17

When to add another drug (to metformin) for T2DM

Answer 17

if the HbA1c has risen to >= 58 mmol/mol (7.5%)

Question 18

Men 1, Men 2a, Men 2b

Answer 18

Men 1: 3 Ps: Parathyroid, Piruitary, Pancreas. Men 1 gene, commonly presents as hypercalcaemia
Men 2a: 2Ps: Parathyroid, Phaeochromacytoma, Medullary thyroid cancer. RET oncogene
Men 2b: Phaeochromacytoma, medullary thyroid cancer, marfanoid body, neuromas. RET oncogene

Question 19

osteopenia, erosion of the terminal phalyngeal tufts (acro-osteolysis) and sub-periosteal resorption of bone

Answer 19

Hyperparathyroidism

Question 20

confusion, drunken like state in patient taking quinine

Answer 20

Hypoglycaemia

Question 21

bone complication of long term prednisolone use

Answer 21

avascular necrosis

Question 22

First line Rx for cerebral metastasis

Answer 22

Dexamethasone, reduces cerebral oedema

Question 23

Diabetes diagnosis:

Answer 23

Fasting glucose >7.0
Random glucose >11.1
IF ASYMPTOMATIC, DO 2 READINGS

Question 24

useful in T2DM patients who are obese (in addition to metformin)

Answer 24

Gliptins

Question 25

Investigation needed for someone on carbimazole who is unwell

Answer 25

FBC - rule out agranulocytosis

Question 26

Expected TFTs for sick euthyroid syndrome

Answer 26

Normal/low TSH, Low T3 and T4
In sick euthyroid syndrome (now referred to as non-thyroidal illness) it is often said that everything (TSH, thyroxine and T3) is low. In the majority of cases however the TSH level is within the normal range (inappropriately normal given the low thyroxine and T3).

Question 27

Thyroid nodule, FHx of thyroid disease and difficult to manage hypertension

Answer 27

Medullary thyroid cancer (commonly also have a phaeochromacytoma, explaining the hypertension)

Question 28

Several thyroid nodules, clinically euthyroid, young woman

Answer 28

Papillary carcinoma, commonly have lymphatic spread

Question 29

In type 1 diabetics, blood glucose targets:

Answer 29

5-7 mmol/l on waking and

4-7 mmol/l before meals at other times of the day

Question 30

Hypercholesterolaemia rather than hypertriglyceridaemia

Answer 30

Nephrotic syndrome
hypothyroidism
Cholesystasis

Question 31

Expected bloods (Potassium, acid-base) for Cushing’s disease

Answer 31

Hypokalaemic metabolic alkalosis

Question 32

Decreased secretion in reduce to stress (surgery)

Answer 32

Insulin
Testosterone
Oestrogen

Question 33

t2dm patient, on insulin. What HbA1c threshold to add another drug

Answer 33

58mmol/mol (7.5%)

Question 34

ECG changes associated with hypocalcaemia

Answer 34

Corrected QT interval prolongation

Question 35

Drug causes of hyperprolactinaemia

Answer 35

metoclopramide, domperidone
phenothiazines
haloperidol
very rare: SSRIs, opioids

Question 36

In type 1 diabetics, a general HbA1c target of… should be used

Answer 36

48mmol/mol

Question 37

Deficiency of which electrolyte can cause calcium deficiency

Answer 37

magnesium, needed for calcium absorption (helpss PTH activity)